Afrezza (Insulin Human)

By Rebecca Dugas

Afrezza is the brand name of a powdered form of human insulin analog that is inhaled through the mouth. Afrezza is designed to help people with diabetes achieve blood sugar control by managing mealtime spikes.

This is a relatively new form of insulin. It was developed by MannKind Corporation and received FDA approval in June 2014, about three years after the FDA asked MannKind to run additional clinical studies on Afrezza. It hit the market in February 2015.

How Does Afrezza Work?

Afrezza is a powder placed in carrier particles that are drawn into the lungs using a special, whistle-size inhaler designed specifically for this medication. Both the cartridges containing the insulin powder and the inhaler are disposable (each inhaler can be used for 15 days).

Afrezza should be administered at the beginning of a meal or within 20 minutes after starting to eat.

Once you inhale the powder from the inhaler, you have to hold your breath for about 10 seconds to allow as much of the medication as possible to get into your lungs.

Dr. Gary Scheiner from IntegratedDiabetes.com reviewed Afrezza and said, “From my experience (and that of some of my colleagues), they have about half the potency of injected insulin, so they can be treated as 2, 4 and 6 units. If you need more than 6 units, you would simply load another cartridge and do a second inhalation.”

Of course, everybody is different, so you will need to experiment with Afrezza to see how well it affects your blood sugars and adjust accordingly.

How Fast Does Afrezza Work?

Afrezza is one of the insulins in the ultra-fast-acting class, which means it begins working to lower your blood sugars within five to fifteen minutes of inhaling it. Its peak action occurs about 20-30 minutes after inhalation, and it is gone from your system within two to three hours.

Larissa Zimberoff of A Sweet Life shared her experience using Afrezza and said that for her, the medicine peaks in 12-15 minutes and is out of her system within 45 minutes.

Since Afrezza is absorbed by the cells of the lungs, it can transfer to the bloodstream much more rapidly than injectable insulins. This means it takes effect more quickly and comes closer to the effectiveness of a normally-functioning pancreas.

Some people who have been on insulin pumps have even been able to stop using their pumps because Afrezza is a more convenient and reliable way to take small doses of insulin as needed. However, it’s important to always check with your doctor before making changes to your treatment protocols.

Who Should Take Afrezza?

It can be prescribed to adults with type 1 or type 2 diabetes, but it has not yet been established as safe for children under 18 years old.

Many people with type 2 diabetes can enhance their blood sugar control with mealtime inhalations of Afrezza, combined with oral medications, diet, and exercise.

One study reported on by WebMD showed that “people with type 2 diabetes who weren’t getting enough control of blood sugar with oral medications did better when they added inhaled insulin before meals.”

Those with type 1 diabetes have found Afrezza works well to bring down spikes and prevent them if taken with meals. Afrezza works well in conjunction with a long-acting insulin, such as Lantus.

Afrezza is not designed to replace long-acting insulins. If you are already on a long-acting insulin, you may benefit from Afrezza as a way to manage mealtime spikes, in addition to your long-acting type.

Afrezza can be an effective alternative for those who have needle aversions or phobias.

Who Should Not Use Afrezza?

Children under the age of 18 should not use Afrezza at this time, since testing has not yet proven whether or not it is safe for children.

Anyone with diminished lung capacity, trouble breathing, COPD, or any type of asthma should not use Afrezza. This medication can exacerbate those conditions.

Smokers and those who have only recently stopped smoking should not use Afrezza, either.

If you have kidney or liver problems, Afrezza is not for you.

Pregnant and nursing mothers should not take Afrezza. According to the drug’s website, “Afrezza may harm your unborn or breastfeeding baby.”

What Are the Side Effects of Afrezza?

However, one study conducted by diabetes specialist, Dr. Bruce Bode, in conjunction with the drug’s developer, MannKind Corporation, showed that patients using Afrezza were actually less likely to suffer from hypoglycemia, compared to those who use other types of fast-acting insulins, such as NovoLog.

Headaches

Diarrhea

Tiredness

Nausea

Cough

Throat pain or irritation

Acute bronchospasm (tightening of the lungs/chest)

Before a doctor can prescribe Afrezza for you, you’ll have to complete a detailed medical history, physical examination, and undergo a breathing test (spirometry) to see if you’re a good fit for this particular type of insulin.

Your doctor should then do another lung function test after you’ve been using Afrezza for six months, and again after one year, to assess whether the medication is affecting your lung function.

Afrezza may or may not be associated with an increased risk of lung cancer. Here’s what the FDA-approved label says about it:

In clinical trials, two cases of lung cancer, one in controlled trials and one in uncontrolled trials (2 cases in 2,750 patient-years of exposure), were observed in participants exposed to AFREZZA while no cases of lung cancer were observed in comparators (0 cases in 2,169 patient-years of exposure). In both cases, a prior history of heavy tobacco use was identified as a risk factor for lung cancer. Two additional cases of lung cancer (squamous cell) occurred in non-smokers exposed to AFREZZA and were reported by investigators after clinical trial completion. These data are insufficient to determine whether AFREZZA has an effect on lung or respiratory tract tumors. In patients with active lung cancer, a prior history of lung cancer, or in patients at risk for lung cancer, consider whether the benefits of AFREZZA use outweigh this potential risk.

What Are the Benefits of Using Afrezza?

It’s small and discrete. The inhaler fits in the palm of your hand. The cartridges are the size of Monopoly game pieces.

It doesn’t require as much equipment to carry around with you.

You don’t have to worry about needles and injections.

It clears the system quickly so that you don’t get surprised by low blood sugars hours after eating. The flipside of this is that if your meal consisted of complex carbs and other foods that break down slowly, your blood sugar may still be on the rise when Afrezza is done working. This means you may have delayed post-prandial (after eating) spikes.

Afrezza is still new enough that you should talk at length with your doctor about whether or not you’re a candidate for this medication. Then be open to experimenting with it a bit to discover how it works for you.

Comments

Which study indicates that Afrezza can cause lung cancer? I think this article is reporting rumors rather than factual information. In addition, I haven’t read any studies stating that Afrezza causes diabetic ketoacidosis. The author needs to link the studies at the bottom of this article.

Here’s what is says about lung cancer: “5.5 Lung Cancer. In clinical trials, two cases of lung cancer, one in controlled trials and one in uncontrolled trials (2 cases in 2,750 patient-years of exposure), were observed in participants exposed to AFREZZA while no cases of lung cancer were observed in comparators (0 cases in 2,169 patient-years of exposure). In both cases, a prior history of heavy tobacco use was identified as a risk factor for lung cancer. Two additional cases of lung cancer (squamous cell) occurred in non-smokers exposed to AFREZZA and were reported by investigators after clinical trial completion. These data are insufficient to determine whether AFREZZA has an effect on lung or respiratory tract tumors. In patients with active lung cancer, a prior history of lung cancer, or in patients at risk for lung cancer, consider whether the benefits of AFREZZA use outweigh this potential risk.”

I’m going to update this page to expand on this detail so people understand the precise information from the study. I agree that it’s unclear as written.